Aanmelding - De Peuterboerderij

EN | NL

Registration for De Peuterboerderij

Requested childcare

Beste ouder(s)/verzorger(s),

Wilt u bij de toelichting aangeven of u gebruik wilt maken van pakket 1 (na 08.00 uur- 18.00 uur) of pakket 2 ( na 07.00 uur- 18.00 uur). Zie voor uitleg de pagina 'tarieven' op de website.

Startdate*
Enddate

Remark

Child

You will be able to register another child after submitting the first registration

Initials*
First name*
Last name prefix
Last name*
Phonenumber (Incase of emergency)*

Date of birth*
Estimated date of birth / Not yet born
Country of birth *
Nationality*
Spoken language*
Religion
Gender*
Citizen number (BSN)*

Nickname*
Allergies
Medication
Medical notes
Vaccinations
Health insurance
Health insurance policy number
May be picked-up by

Doctor/General practitioner
If your Doctor/General practitioner is not mentioned in the list, can you please write them in the remark field above?

Parent/Guardian 1 (Who will receive the invoices)

Title
Initials*
Firstname*
Last name prefix
Last name*
Relationship*
Date of birth*
Country of birth *
Nationality*
Spoken language*
Citizen Number (BSN)*
Highest education
Profession
Reffered for VVE (Preschool education)
Personal situation
Combined income
Streetname*
House number*
House number extension
Postalcode (numbers)*
Postalcode (characters)*
City*
Country*
Phone number (Home)
Mobile phone number*
Phonenumber (work)
E-mail address*
IBAN*
BIC/SWIFT code (if applicable)

Parent/Guardian 2

Title
Initials
Firstname
Last name prefix
Last name
Relationship
Date of birth
Country of birth
Nationality
Spoken language
Citizen Number (BSN)
Highest education
Profession
If you do not enter an address here, the address of parent/guardian 1 will be automatically taken over.
Streetname
House number
House number extension
Postalcode (numbers)
Postalcode (characters)
City
Country
Phone number (Home)
Mobile phone number
Phonenumber (work)
E-mail address
BIC/SWIFT code (if applicable)

Emergency person

Title
First name*
Last name prefix
Last name*
Relation

Phone number (Home)
Mobilephone number*
Phone number (work)

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